Download File - Janel Canty Nursing E

 To
decrease the rate of central line
associated blood stream infections
 To increase knowledge on the purpose
and effectiveness of chlorhexidine
gluconate (CHG) baths in preventing
CLABSI's
 To understand the proper
documentation of CHG baths in Cerner
 Central
Line:
 An
intravascular catheter that terminates at
or close to the heart in one of the great
vessels
 Used for infusions, withdrawal of blood, or
hemodynamic monitoring
 CLABSI:
A
laboratory confirmed bloodstream
infection where the central line was in place
>2 calendar days on the date of the even
 Broad
spectrum anti-microbial properties
 Works against MRSA and VRE
 Low toxicity
 Immediate and long-acting protection
 NPSG.07.03.01
 Use
proven guidelines to prevent infections
that are difficult to treat.
 NPSG.07.04.01
 Use
proven guidelines to prevent infection of
the blood from central lines.
 Medications,
catheter changes, lab tests,
ICU transfers
 Each CLABSI costs about $16, 550 per
patient
 As of 2008, hospitals are not reimbursed
by CMS for CLABSIs that were not present
on admission
 Between
12-15% of patients who acquire
a CLABSI die
 Roughly 250,000 cases per year  62,000
patients die
 Extended hospital stays
 Bayfront
 Rate
 Florida
 Rate
 United
 Rate
CLABSI Rates:
of Infection: 1.11
CLABSI Rates:
of Infection: 0.57
States CLABSI Rates:
of Infection: 0.56
Rizzo, E. (2014).
 Plan-Do-Study-Act
Improvement Method
 Cause & Effects Analysis- Fishbone
Diagram
 Process Flow Charting
Nurse receives
report that patient
has a PICC line
At an appropriate
time, the nurse
prepares to give
CHG bath
Chlorhexidine
gluconate wipes
gathered from
supply room
Use new CHG
wipe for each
area of the body
Wipe only from the
neck down, clean
to dirty
Nurse begins CHG
bath with wipes
Document CHG
Bath in Cerner
Monitor for signs &
symptoms of
possible infection
Remind the next
nurse about CHG
bath protocol at
shift-change
 Nurse
Manager
 Registered Nurses
 Patient Care Techs
 PICC Nurses
 Track
the number of line days for each
patient with a central line
 Documentation of chlorhexidine
gluconate baths given to patients with a
central line
 Track and document the patients that
develop central line associated blood
stream infections
 Results
for CLASBI indicate a 53% rate
reduction during CHG intervention (Karki
2012)
 In one community hospital, CLASBI rates
decreased from 3.8 to 1.6 per 1000
central line days, in 6 months of
beginning the CHG bath intervention
(Miller 2012)
 VISION
 CLASBI
is largely preventable and a rate of
ZERO is an achievable goal (Miller 2012)
 Proper
 CHG
Techniques to Perform CHG Baths:
wipes should not come into contact with
eyes or ears
 Only use CHG wipes below the jaw line
 Use a firm massage to remove bacteria
 Use a new cloth for each area of the body
 Let CHG air dry- do not wipe or rinse off
 Do not use soap and water on the skin after CHG
baths
 Dispose of CHG wipes in the trash DO NOT flush
 CHG baths should be given DAILY
IV Care
IV PICC
Line Site
CHG
Bath
Yes/No
 Float
nurses will need to be educated
about the CHG bath protocol for
patients with central lines
 Centers
for Disease Control and Prevention, (2014).
Central line associated blood stream infection event.
Retrieved from website:
http://www.cdc.gov/nhsn/PDFs/pscManual/4PSC_C
LABScurrent.pdf
 Centers for Disease Control and Prevention. (2011).
Vital signs: Central line-associated blood stream
infections . Morbidity and Mortality Weekly Report,
60, 1-6. Retrieved from
http://www.cdc.gov/mmwr/pdf/wk/mm60e0301.pdf
 Centers for Medicare and Medicaid Services. (2008,
October 01). Hospital-acquired conditions (present
on admission indicator). Retrieved from
http://www.cms.gov/Medicare/Medicare-Fee-forServicePayment/HospitalAcqCond/index.html?redirect=/Ho
spitalAcqCond/06_Hospital-Acquired_Conditions.asp
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Karki, S., & Cheng, A. (2012). Impact of non-rinse skin cleansing with
chlorhexidine gluconate on prevention of healthcare-associated infections
and colonization with multi-resistant organisms: a systematic review. Journal
Of Hospital Infection, 82(2), 71-84. doi:10.1016/j.jhin.2012.07.005
Miller, S., & Maragakis, L. (2012). Central line-associated bloodstream infection
prevention. Current Opinion In Infectious Diseases, 25(4), 412-422.
The Joint Commission. (2014). Hospital national patient safety goals. Retrieved
from http://www.jointcommission.org/assets/1/6/2014_HAP_NPSG_E.pdf
The Joint Commission. Preventing Central Line–Associated Bloodstream
Infections: A Global Challenge, a GlobalPerspective. Oak Brook, IL: Joint
Commission Resources, May 2012. http://www.PreventingCLABSIs.pdf.
The Leapfrog Group. (2013, October). Retrieved from Hospital safety score:
http://www.hospitalsafetyscore.org/hospital/bayfront-medical-center-inc
Rizzo, E. (2014). Infection control & clinical quality. Beckershospital review.
Shaffer, J. (2012). Bathing with chlorhexidine (chg) cloths . Infection Control
and Epidemiology, Retrieved from
http://www.med.umich.edu/1libr/infectioncontrol/CHG.pdf
World Health Organization. (2014). Preventing blood stream infections from
central line venous catheters . Retrieved from
http://www.who.int/patientsafety/implementation/bsi/en/